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IIIIIM • PERMIT APPLICATION• <br /> LILIM <br /> UILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> EVERETT CiTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINOTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 5 `J V V , CI S t o O (2_.d PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION /� <br /> OWNER NAME: kl(,(, ') J cN) p�'iy,,j - TENANT BUSINESS NAME(Commercial): A\S $&)\Y`S CLA- b <br /> OWNER MAILING ADDRESS: STREET t 26 " . Ca g 1 n 0 FG(' ' /'A— 1 �/ G <br /> CITY 1/v �V e l STATE V V V ZIP `� 0 20 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: CUIi , z(�.:-.70,,61,1r7-,,_ 1/4g4L <br /> CONTRACTOR ADDRESS: STREET Z(ZO�_l'~�PA-Ct.& �J <br /> CITY E V(���1 STATETT [.e .�tAs i ZIP "t/ `4/I <br /> CONTRACTOR PHONE: (12\) 2_5Z-.3/(Li- CONTRACTOR EMAIL: C ay 1%St e m'wa,`C n'Yl <br /> CONTRACTOR LICENSE#(REQUIRED): .U& ,(55So2ZC}1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):c t)'7 9 SS <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: �/�/ c ` CONTACT PHONE: ((C'.1 tZ.s ..>07 Z3 <br /> O 1 It.& SSCV &k,(X\nos is CONTACT EMAIL: l r 1a..iC\s e5sc!riutgu C m <br /> BUILDING INFORMATION C d <br /> Existing Use of Building: Contract Price of Work:$ ‘-J}C.t <br /> Proposed Use of Building: Heat Source: Gas ❑iEllectric DOther , <br /> BUILDING USE: DSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: `ram,ommercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: PanNise. <br /> I per,, M��� gas c,1 k k- <br /> an Lac;v,c diA u j `,�tk ut, ) 0- heat-Fiv . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> ( A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains • <br /> Water Heater <br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System No.of Heads <br /> ACKNOWLEDGEMENT:i have reviewed this application and confirm the Information contained herein is(rue and correct,Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized In writing from the <br /> Building Official before being authorized under any circumstance,I am the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 6 <br /> 0�7✓ner/ uthorized Agent Stgnafure Date (Revised 10/10/2018) <br />